NPI | 1932762861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5769) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002333) |
152W00000X Optometrist (Licence: WA OD60878885) | |
Enumeration Date | 2019-04-16 |
Last Update Date | 2022-11-04 |